HomeMy WebLinkAboutAPPLICATION MECHANICAL - 16-00683-684 - Sugar Mill ApartmentsCITY OF
REXBURG
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Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Mechanical Work
0 Mechanical Fees Paid
Name: -----~--~~~~-1d.....C..----
Address: ________ -:__ ___________________ City: ______________ State: _______ Zip Code: __________ _
Phone:----------~-----~------Email:-------------------------------
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
0 Yes (Skip to and complete the Homeowner's Exemption)
Under Idaho Building Code, a registered contractor must do the work fora Commercial Building.
Business: ~.u_~~ _ _.__.u..c _______ State License#: -~~~-~Exp.: -~\.3ni.~--
Address: _2:,_l_'"l£._ _ _1,l__=z..c;o v._::, City:--~~~ 'L.. State:--~---Zip Code: ~3\.~
Phone: --~~~3. -C.07Ac;>-:::l____ Email: ""-o ~ . . c:u ' _
Contact(Rop.Namoo~l'~ailo __ ~------
Mechanical Contractor Authorized Signature:------~ ______________ Date:~::d~~e-{-L=7
.., d\-V-~-Address: -~.\.--l..l-d. ':"1 ~ -OR-
What type of Property: D Residential )(1 Commercial
Costofjob: $ _ _1~~~
Description of work:~~-------
Check all that apply:
0 Furnace or A/C = $65
0 Gas Line = $65
0 Water Heater= $65
i.Vurk
Lot#: Block#: Subdivision:--~--------------
0 Fireplace/Solid Fuel Burning Unit:
o Built-in= $130
o Free-standing = $65
0 Miscellaneous/Requested Inspection= $65
Inspection fees can be bundled upon request. Re-inspect fees will be enforced if inspection requests exceed fee totals.
APPLICANT"S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certifY that I have read this application and state that the information herein
is correct and f swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall he truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days. a ~
Applicant's Name (print): _"Zc~~~ Signature:_£ ~ Date: _'d.~-4-/
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline-(208) 372.2344 www.rexburg.org Permit Technician-(208) 372.2341